FAMILY MEDICINE VOL. 48, NO. 2 • FEBRUARY 2016 121 ORIGINAL ARTICLES T he practice of medicine de- mands the highest possible skills in diagnosis and evi- dence-based therapeutics. However, cognitive errors can result in di- agnostic and management errors. 1 For example, misdiagnoses arise from fawed data gathering and/or misinterpretation of data. 2 The best physicians think critically and prob- lem solve through appropriate gath- ering and accurate interpretation of information. 3 Critical thinking (CT) is the skill of collecting appropriate information, accurately assessing information, and using that information to reach a considered conclusion. CT integrates six primary skills: in- terpretation, analysis, evaluation, inference, explanation, and self- regulation. 4,5 Previous research shows that health care profession- al trainees’ performance on critical thinking tests correlates with aca- demic clinical decision-making 6 as well as with academic success. 7 Some research, though limited, suggests a positive relationship between CT skills and professionalism. 8,9 Despite the clear value of CT skills in health care professions, taking the approach of teaching CT skills to trainees is problematic. In some studies CT is unchanged by training programs, 10,11 while in oth- er studies CT improves with edu- cation. 12 One way to ensure good CT skills in trainees is to select for trainees that already demonstrate those skills. To do this, programs could include CT skills assessment during medical school or residency selection. While many CT studies to date examined nursing, pharmacy, or dental hygiene, few studies have examined physicians in training. 13-15 There is some work being done in the United Kingdom, where the situ- ational judgement test incorporated From the Department of Family Medicine (Drs D Ross, Schipper, Banh, Loeffler, Allan, and S Ross) and Department of Psychology (Dr Westbury), University of Alberta. Examining Critical Thinking Skills in Family Medicine Residents David Ross, MD; Shirley Schipper, MD; Chris Westbury, PhD; Hoan Linh Banh, PharmD; Kim Loeffer, MD; G. Michael Allan, MD; Shelley Ross, PhD BACKGROUND AND OBJECTIVES: Our objective was to deter- mine the relationship between critical thinking skills and objec- tive measures of academic success in a family medicine residency program. METHODS: This prospective observational cohort study was set in a large Canadian family medicine residency program. Interven- tion was the California Critical Thinking Skills Test (CCTST), admin- istered at three points in residency: upon entry, at mid-point, and at graduation. Results from the CCTST, Canadian Residency Match- ing Service fle, and interview scores were compared to other mea- sures of academic performance (Medical Colleges Admission Test [MCAT] and College of Family Physicians of Canada [CCFP] certif- cation examination results). RESULTS: For participants (n=60), signifcant positive correlations were found between critical thinking skills and performance on tests of knowledge. For the MCAT, CCTST scores correlated posi- tively with full scores (n=24, r=0.57) as well as with each section score (verbal reasoning: r=0.59; physical sciences: r=0.64; biologi- cal sciences: r=0.54). For CCFP examination, CCTST correlated reli- ably with both sections (n=49, orals: r=0.34; short answer: r=0.47). Additionally, CCTST was a better predictor of performance on the CCFP exam than was the interview score at selection into the resi- dency program (Fisher’s r-to-z test, z=2.25). CONCLUSIONS: Success on a critical thinking skills exam was found to predict success on family medicine certifcation examina- tions. Given that critical thinking skills appear to be stable through- out residency training, including an assessment of critical thinking in the selection process may help identify applicants more likely to be successful on fnal certifcation exam. (Fam Med 2016;48(2):121-6.)